Sarcopenia
The progressive loss of muscle mass associated with ageing — and preventable
Definition
Sarcopenia is the progressive and generalised loss of skeletal muscle mass and strength associated with ageing. Defined by the European consensus EWGSOP2 (2019) as the combination of low muscle strength (primary criterion: <27 kg men, <16 kg women on handgrip), confirmed with low muscle mass (appendicular lean mass index <7.0 kg/m² men, <5.5 kg/m² women on DEXA) and severity evaluated by low physical performance (walking speed <0.8 m/s). It predicts frailty, functional dependence, hospitalisation, and mortality better than many other markers.
Detailed explanation
Multifactorial pathogenesis: reduced protein anabolism with age (anabolic resistance), decline of satellite cells (muscle stem cells), denervation and reinnervation (loss of motor units), chronic low-grade inflammation (catabolic IL-6), reduced testosterone/GH/IGF-1, intramuscular fat infiltration (myosteatosis), chronic sedentarism, suboptimal protein diet.
Natural loss is ~1% per year from age 30, accelerating to ~3% per year after 60 if not actively counteracted. Advanced sarcopenia is associated with osteoporosis (osteo-sarcopenia, marker of frailty), falls, fractures, hospitalisations, loss of independence, and mortality.
Documented prevention and treatment:
Progressive strength training: most effective intervention. 2-3 sessions/week, 8-12 reps, 70-85% 1RM, exclusion of non-technical muscle failures. Studies show that those over 80 recover muscle mass with structured training. Dietary protein: 1.2-1.6 g/kg/day in those over 50 (more than the traditional RDA of 0.8 g/kg). Distribute in 3-4 meals with ≥25-40 g protein/meal to overcome anabolic resistance. Leucine: key branched-chain amino acid (leucine threshold ≥3 g/meal activates muscle synthesis). Vitamin D: correction to >40 ng/mL improves muscle function in deficient individuals. Creatine monohydrate: 3-5 g/day. Robust evidence for muscle mass preservation in older adults. GH/IGF-1 secretagogues: CJC-1295 + Ipamorelin in selected profiles with low anabolic endocrine function. HRT in confirmed hypogonadism: testosterone, in men with T <300 ng/dL and symptoms.
Scientific sources
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